***Airport Employees should use the internal reporting system, not this form***

This objective of this form is to facilitate the collection of information on actual or potential safety deficiencies thus contributing to the identification and implementation of safety improvement measures. Brighton City Airport Ltd promotes a positive safety culture and the Aerodrome Management review all submissions.

You may choose not to provide your name and submit this form confidentially.

Under no circumstances will the Aerodrome Management disclose your identity or contact details to any other person in the airport or to any other organisation, agency or person without your express permission.

* Required

Date of occurrence *

MM

/

DD

/

YYYY

Time of occurence

Time

:

AM

PM

Category Of Occurence *

Choose

Aerodrome Equipment Fault/Failure/Damage

Landside (Car Park/Road/Buildings)

Personal Injury or Accident

Security/Crime/Malice

Unknown/Other

Description/Narrative of the occurrence *

Please make the report as detailed as possible, providing specific evidence where necessary

Your answer

In your opinion, what is the likelihood of this happening again? *

Extremely Unlikely

Unlikely

Possible

Quite Likely

Certain

What do you consider would be the worst possible consequence if this happened again? *

Negligible/None (Little or no consequence)

Minor (Nuisance/Operating limitations/Use of First Aid)

Tolerable (Reduction in safety margins/Injury >3 days absence from work)

Major (Serious Injury or disablement/Significant damage to property or equipment)

Catastrophic (Death/Equipment or Infrastructure destroyed)

What or who would be most affected? *

Environment (Flora & fauna/Watercourses)

Local Businesses

Vehicles/Transportation

Airport Buildings & Infrastructure

Aircraft

Members of the public

Airport Staff

Contractors

Air crew/Passengers

Other:

Required

What is your recommendation for preventing such an occurrence in the future?